Fixators General Missing digits

Digital Lengthening

Shortened digits are a common concern of parents when their child is born with a difference. For most kids, lengthening does not make sense as it will not improve function or appearance. However, for some kids, the procedure can make a big difference. The most common situation is amniotic constriction band in which digits are shortened and lengthening one or two digits can markedly improve function

This is a different type of hand difference, related to infantile polyarteritis nodosa. I have known this patient and her family since birth and on recent followup, we were all so happy with her status. Polyarteritis nodosa is a vasculitis which can lead to digit loss, among other concerns. Unfortunately, she had necrosis of all of her fingers which made function difficult. At an early surgery on her left hand, we removed the 2nd metacarpal which helped a bit with pinch.

Last year, and with the increased demands of an 11 year old, function became more challenging. While two handed activities were able to be accomplished, fine motor skills were difficult. Therefore, we elected to lengthen the thumb and little finger metacarpals to provide larger pinch and grasp. She has done wonderfully and is considering the timing for surgery on the right.

External fixators in place to start lengthening digits
External fixators in place for lengthening

Gradual lengthening of these two bones is painless and typically requires a few months to heal. Secondary surgery is required to remove the fixator. When lengthening the thumb, we typically deepen the first webspace when we remove the fixator. Finally, sometimes we have to add bone graft and a plate to achieve bone healing after lengthening. Function can be dramatically improved.

Able to write with a pen after thumb lengthening.
Larger object grasp after lengthening
Application of lengtheners on left thumb and little finger metacarpals. note the kwire securing the thumb base to limit the risk of joint dislocation.

Leave a Reply

Your email address will not be published. Required fields are marked *